Low back pain is a common disease globally. In 1990 the incidence of low back pain was 377.5 million, in 2017 the incidence increased to 577.0 million.
Low back pain increases with age and is the leading cause of disability worldwide. Western Europe has the highest number of disability claims due to low back pain. In one study, it was the most common pain reported in the US with the adults surveyed 25% stated they has some type of low back pain within the last 3 months. In a second study, this number increased to 39%.
Acute back pain is defined as lasting less than 4 weeks.
Subacute back pain lasts 4-12 weeks.
Chronic back pain lasts greater than 12 weeks.
In adults, 84% have low back pain some time in their lives. The percentage of adults who had neck or back pain for 5 years or longer is 54%, while the percentage of adults who took NSAID for their neck or back pain is 73%.
Percentage of US males who experienced back pain in the past 3 months is 37%. Percentage of US adults over 65 who experienced back pain in the past 3 months is 45.6%. In a meta-analysis surveying US adults, from 2004 to 2016, the average percentage of adults with complained of low back pain was 28.4% All told, treatments for lower back and neck pain cost 77 billion by private insurance, 45 billion by public insurance and 12 billion out of pocket as reported from the Institute for Health Metrics 2020.
Americans spent more, out of pocket, for back pain than diabetes and heart disease.
CAUSES Of LOW BACK PAIN
Low back pain can have multiple etiologies but most commonly
- Muscle or Ligamentous strain caused by repeated heavy lifting with poor body mechanics
- Osteoporosis causing micro-fractures in bones. They become porous and brittle with this disease
- Arthritis in the spine can impinge on the nerves and narrow the area around the spinal cord. Also, forming osteophytes that can impede or impinge nerves
- Bulging or Herniated Discs- this is the cartilaginous areas between the vertebrae that act as shock absorbers. The soft material inside can herniate and impinge on the nerves innervating the leg
- Intervertebral Disc Disease or Degenerative Disc Disease
Intervertebral Disc Disease or Degenerative Disc Disease
It is estimated the affect 5% of the population in developed countries.
Degenerative Disc Disease is a condition that is characterized by the degeneration or breakdown of the discs separating the vertebrae in the spine, commonly occurring in the lumbar area but can also affect the cervical area. As these discs degenerate, they are prone to herniation causing pressure or impingement on the spinal cord itself or the nerves that innervate the lower extremities. These discs can continue to degenerate and not only cause pain in the lower areas of the leg(sciatica) but can compress the spinal cord and cause difficulty walking and bladder and bowel control.
CAUSES of DEGENERATIVE DISC DISEASE
- Aging- this disease process in commonly a problem of aging usually over the age of 40
- Smoking- Coughing increases pressure on the discs also decreasing blood flow to the area
- Chronic Inflammatory Conditions and Auto-immune Disease states such as Rheumatoid Arthritis
- Repeated Trauma- such as chronic Lifting, sports, work related such as a truck driver
- Infection in the area or cancers and diseases causing inflammatory spine problems
- Genetics- Variations in the production of collagen thought to be genetic can decrease the stability of the disc causing degeneration over time
- Scoliosis- curvature of the spine
- Spondylolisthesis- where there is excessive abnormal movement of the spinal vertebrae
- Biologic sex- women greater than men
- Psychological conditions- depression and anxiety has an associated greater risk of back pain and problems
- CT or MRI
- Blood tests
- Bone Scans- evaluate osteoporosis, compression fractures, cancers
- Nerve conduction studies
Preventative treatments include:
- Discontinue Smoking
- Maintain healthy body weight
- Exercise to increase core strength and overall flexibility
- Physical Therapy- Increase mobility and strengthening, teach proper body mechanics such as lifting
- Assistive Devices- Cane, walker, bracing
- Medications- NSAIDS, Muscle Relaxers, Corticosteroids short term, Seizure Meds, Anti-depressants, Narcotics not indicated for long term use
- Epidural Steroid Injections- used to reduce inflammation and pain
- Radio-frequency ablation- electric currents to burn the sensory nerves sending pain signals to the brain therefore preventing the chronic pain
There are multiple types of surgical procedures designed to remove pressure from the spinal cord or nerves;
- Diskectomy- removing part or all of the disc
- Foraminotomy- expanding the exit area of spinal nerves from the vertebra area
- Laminectomy- Small part of the vertebrae is removed to take pressure of the cord and nerves
- Spinal Fusion- the disc is totally removed and the vertebrae are joined to improve overall stability
Platelet-Rich-Plasma is an autologous blood concentrate with super-physiologic amounts of growth factors, cytokines and other proteins that repair and regenerate damaged tissue in the body. Clinical application of platelet-rich-plasma is gaining popularity and is being used in patients who have degenerative disc disease. PRP promotes tissue repair and cellular growth by anabolic effects of several growth factors released from activated platelets. Below are studies to support the use of Platelet-Rich-Plasma in the disease process of degenerate disc disease.
- Platelet-Rich-Plasma versus Corticosteroid for the Treatment of Discogenic Low Back Pain: A Double-Blind Randomized Controlled Trial
J Clin Med 2022 Jan;11(2):304 PMID 35053999
Comparison was made between two groups, one receiving PRP and the other corticosteroid injection for the pain and disability associated with disc disease
Conclusion- The intradiscal injection of PRP showed significant improvements in low back pain intensity in patients with discogenic low back pain, similar to those injected with glucocorticoid at eight weeks post injection. PRP treatment was safe and maintained improvements in pain and disability during 60 weeks of follow up.
- Platelet-Rich-Plasma in the Management of Chronic Low Back Pain: A Critical Review J Pain Res 2019; 12: 753-767. PMID 30881089
The main function of the platelets is to contribute to hemostasis through adhesion, activation and aggregation. In addition to the factors that coagulate blood, platelets released from platelets increase inflammation and revascularization and to accelerate regeneration in the inflammatory and proliferative stages of wound healing. Once platelets are activated, these bioactive proteins are generated and released to the damaged tissues synergistically regulate multiple pathways for tissue repair. Multiple studies were evaluated for the use of PRP in intra-discal disease
Conclusion- All the studies reported that PRP was safe and effective in reducing back pain. There is a great possibility that the application of PRP has the potential to lead to a feasible intradiscal therapy for the treatment of degenerative disc disease. The author stated further large-scale studies may be required to confirm the clinical evidence of PRP for the treatment of discogenic low back pain.
- Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians Guidelines Pain Physician 2019 Jan;22(15):S1-S74 PMID 30717500
Regenerative medicine is a medical subspeciality that seeks to recruit and enhance the body’s own inherent healing armamentarium in the treatment of patient pathology. This therapy’s intention is to assist in the repair or to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics.
Objective: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine
Conclusion- Lumbar Disc Injections based on the available evidence regarding the use of platelet-rich-plasma, including one high-quality randomized controlled trial, multiple moderate quality observational studies, a single arm meta-analysis and evidence from a systemic review, the qualitative evidence has been assessed as Level III on a scale of Level I to Level IV. Regenerative Therapy should be provided to patients following diagnostic evidence of a need for biologic therapy
- Intradiscal Platelet-Rich-Plasma Injection for Discogenic Low Back Pain and Correlation with Platelet Concentration: A Prospective Clinical Trial (Pain Med 2020 Nov1;(11):2719-2725 PMID 32869064)
The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at 3 and 6 months
Conclusion- This study supports the use of intradiscal PRP for the treatment of discogenic pain with preferably higher platelet counts to elicit a favorable response
Juventix Regenerative Medical provides FDA approved PRP kits to produce super-physiologic concentrations needed for use in regenerative applications. The kit is reliable and cost effective producing scientifically proven concentrations of PRP from the same source. The kit is designed for safety and effectiveness.
Juventix Regenerative Medical has a patent pending LED activator that activates the platelets producing higher concentrations of growth factors and cytokines without the use of chemical additives such as Calcium Chloride or Thrombin. Therefore, Juventix is well within the recent FDA guidelines for minimal manipulation of human tissue based products.
Juventix Regenerative Medical has a patent pending Bio-Incubator that converts the Platelet-Rich-Plasma to a Flowable Platelet-Rich-Fibrin which is the second generation of platelet regenerative products. This provides new and longer acting anti-inflammatory applications for use in many applications.
Restore, Revive, Regenerate – Juventix Regenerative Medical
Dr. Robert McGrath